Removal of a Septal Extension Graft and Pinocchio Nose Correction: A Case

 
Removal of a Septal Extension Graft and Pinocchio Nose Correction: A Case
(Removal of SEG and correction of Pinocchio nose via closed incision)

This refers to a shape in which the tip is excessively high for the height of the dorsum and the dorsal line

breaks near the supratip region.

At another clinic, 3 years earlier, this patient had undergone tip plasty with ear cartilage; then,

1 month ago, at a 3rd clinic, received a septal extension graft using septal cartilage.

The tip then became overprojected like Pinocchio's and deviated, and the patient visited our clinic for improvement.

In the frontal view, the bridge is deviated and the tip is shifted to the patient's left. (Caudal septal deviation)

In the lateral view, the tip is far too high relative to the dorsum, a typical Pinocchio nose shape. (Pinocchio nose)

The bridge and tip are diagnosed as having deviated because the septal extension graft was made excessively high and long,

placing tension on the tip skin, and the septal cartilage, unable to withstand it, bent.

The tip point leans toward the patient's left.

This is because the cartilage of the septal extension graft was reinforced on one side only,

leaving it unbalanced and shifted to one side.

Assessment of the skin showed high tension,

and the tip felt stiff and firm to the touch.

Because only 1 month had passed since the previous surgery,

the surgical plan was to avoid complex surgery so as not to place major stress on the nose.

1)     Remove the septal extension graft, then reduce the height and length of the tip.

2)     At the supratip, to straighten the broken line, use the removed septal cartilage for an onlay graft.

3) The incision was planned as a closed approach.

With removal of the septal extension graft alone,

the deviated tip and dorsal line were straightened.

The nostril asymmetry and the tilted columella (shifted columella)

have both been corrected, and the nose is now straight and symmetric.

In addition, the exaggerated tip and the deviated shape of the nose were also corrected.

The tip, which had projected like a Pinocchio nose, has been corrected, and the line has settled attractively.

The broken dorsal line has also become straight.